Modified Wheeler Technique with Inferior Lid Retractor Plication for Senile Entropion.

INTRODUCTION: The study aimed to assess the outcome of the modified wheeler technique with lower eyelid retractor plication for the correction of Involutional (senile) entropion among the study patients Materials and methods: A retrospective case series study was conducted in two tertiary eye hospitals of Bangladesh from 1 July to 31 December, 2020. This study included all patients undergoing modified wheeler technique with inferior lid retractor plication and followed up to at least one year and six months between 01 January 2015 to 31 December, 2019. All patients were suffering from senile entropion of the lower eyelid. All surgeries were performed by a single surgeon and the study sample size was selected purposively. Patients were operated by the modification of modified wheeler technique for the correction of lower eyelid entropion in this study. The outcome of the surgical techniques was assessed at regular intervals on each follow up. RESULTS: Thirty eyes of thirty patients were evaluated. Success rate was 100% in the 18 months follow up time with no recurrence in any. Ecchymosis, skin scarring and/or minimal pain were observed as post-operative complications. CONCLUSION: The modified wheeler technique with inferior eyelid retractor plication is the definitive and permanent procedure for the correction of involutional entropion with minimal or no recurrence.

Lacrimal Sac Tumors: A Case Series.

Objective: The aim of the study was to describe the clinical presentation, management strategies, and outcomes in a case series of primary lacrimal sac tumors. Methods: This retrospective study was conducted in Sheikh Fajilatunnessa Mujib Eye Hospital and Training Institute, Bangladesh, from July 1 to December 31, 2020, and included all patients who were evaluated, treated, and followed up for at least 6 months from January 2013 to October 2020. One patient developed a recurrence of the adenocarcinoma of the lacrimal sac after 1 year of primary treatment. Patients' demographic data were analyzed and reviewed from published articles on lacrimal sac tumors. We assessed patients clinically, followed by radiological evaluation. We also analyzed the biopsy technique, treatment modality, and recurrence. An oncologist reviewed all patients to prepare a plan for adjuvant treatment. Results: Ten patients with lacrimal sac tumors were included in this study. Swelling in the medial canthal region was the most common presenting feature (100%), followed by epiphora (60%) and pain (30%). Open biopsy was preferred over fine-needle aspiration biopsy. Incisional biopsy or complete excisional biopsy was performed for all suspected malignancies. Malignant tumors were found in 7 (70%) cases, and benign tumors in 3 (30%) cases. Non-Hodgkin's lymphoma (NHL) (40%) was the most common malignant lacrimal sac tumor. Mucosa-associated lymphoid tissue lymphoma was 75%, and diffuse large B-cell lymphoma was 25% among the cases of NHL. Patients with epithelial malignancy were treated with external beam radiation therapy, while NHL patients were treated with chemotherapy (CHOP regimen). Recurrence was noted in 1 case (10%) of epithelial malignancy after 1 year of treatment. Conclusion: Successful management of lacrimal sac tumors requires a high index of suspicion, as these are fatal tumors, often misdiagnosed as dacryocystitis. Nonepithelial malignancies are more predominant than epithelial malignancies, and hematolymphoid tumors are most frequent.

The study of simultaneous bilateral ocular trauma in Northern India: clinical presentation, epidemiology and patterns of injury.

PURPOSE: This study is aimed to determine the frequency, sociodemographic profile, clinical presentation, patterns of injury, treatment and outcomes of cases of simultaneous bilateral ocular trauma treated in a teaching hospital of Northern India. METHODS: This retrospective study was conducted from May 2015 to April 2019. The medical records of patients presenting with bilateral ocular injuries were reviewed. RESULTS: Among the 402 patients presenting with ocular injuries, 34 (8.5%) had simultaneous bilateral ocular trauma. The majority were male (70.6%), and the mean age was 26.82 ± 15.86 years (range: 2-70 years). The most frequently affected age group has been 16-25 years (35.3%). Most injuries occurred away from home (64.7%), mainly on roads (32.4%) or playgrounds (14.7%), and the vast majority (91.2%) were non-occupational in nature. Mechanical injuries were most frequent (47.1%), followed by cracker (17.7%), chemical (17.7%) and thermal (11.8%) injuries. Most cases occurred due to assault (26.5%), road traffic injury (20.6%) or sports/recreational activities (17.7%). The majority of victims were not using protective devices at the time of injury (82.4%) and had associated polytrauma (58.8%). Closed and open globe injuries accounted for 29.4% and 14.7% of cases, respectively, mostly involving zones I (55.0%) and II (40.0%). Orbital fractures occurred in 27.9% of eyes. Category I and II ocular trauma scores were noted in 5.9% and 7.4% of eyes, respectively. Overall, 13.2% were blinded as a result of the trauma. CONCLUSION: Simultaneous bilateral ocular trauma is rare and occurs mostly following road traffic accidents, assault or recreational activities. In particular, young-adult males are more prone to bilateral ocular injuries, the majority of which are severe and associated with poor outcomes. The study also highlights that poor initial visual acuity, multiple ocular structure involvement, large open globe injury, presence of intraocular hemorrhage, posterior segment injury, multiple orbital fractures and lower OTS were the poor prognostic factors.

Minimally invasive harvesting fascia lata (FL) in ophthalmic plastic surgery.

PURPOSE: To describe a minimally invasive technique of harvesting fascia lata, and also to analyze the clinical uses and the outcome of fascia lata in Ophthalmic Plastic and Reconstructive surgery. METHODS: This interventional study was done in three tertiary care eye hospitals in Bangladesh from July 2014 to June 2020. We obtained autologous fascia lata for the correction of congenital ptosis with poor levator function (⩽4 mm), covering the ciliary staphyloma, repair of the extruded implant following anophthalmic socket surgery, and was also used to wrap the orbital implant after enucleation. Preserved FL was used only for children before 6 years of age for the treatment of congenital ptosis. RESULTS: Out of 60 subjects, 38 (63.3%) were male and 22 (36.7%) were female. Autogenous fascia lata was used for frontalis brow suspension (FBS) in 25 (41.67%) patients of congenital ptosis with poor levator function, as patch graft in ciliary staphyloma (11 cases, 18.3%), to wrap orbital implant following enucleation in intraocular malignancies (nine cases, 15%), to repair of implant extrusion following evisceration (five cases, 8.3%), and as fascial sling to correct recurrent paralytic ectropion (one case, 1.67%). Allogeneic or preserved fascia lata was used to correct congenital ptosis in patients less than 6 years of age (nine cases, 15%). Mean follow-up time was 5.32 months. CONCLUSION: Fascia lata (autogenous and allogeneic preserved) has varied uses in ophthalmic plastic surgery. Harvesting fascia lata (FL) using with minimally invasive method was successful with the least scar on the thigh to correct congenital ptosis, ciliary staphyloma, repair of extruded implant, and in wrapping implant after enucleation to get better cosmesis and motility.